Contact Information

First name *

Last name *

Hometown *

Please enter your hometown city and state

Email *

Cell phone

PERMISSION TO DISCLOSE INFORMATION FROM EDUCATIONAL RECORDS FOR SCHOLARSHIPS, PRIZES, AND OTHER AWARDS

In accordance with the Family Educational Rights and Privacy Act (FERPA), it is the policy of Goucher College to withhold disclosure of personally identifiable information from educational records unless the student has consented to disclosure or FERPA allows disclosure. Please consult the Campus Handbook under “Student Records and FERPA” for more detailed information.

By completing this form, you authorize Goucher College to disclose the following personally identifiable information to the donor whose gift created the scholarship, prize, or other award you are receiving:

your name,
your hometown, and
a brief biography based on the information sheet you provided to the college in connection with your award.

Your agreement to disclose such information is voluntary, and is not a condition of receiving the award. This authorization shall remain in effect until revoked by you. Revocation must be made in writing to Amanda Beard, Assistant Director of Donor Relations, in the Office of Advancement at Goucher College.

I hereby authorize Goucher College to disclose the information described above to the donor of the scholarship, prize, or award I am receiving.

Agree

Disagree

Academic Information

Class year *

Primary academic focus/Intended major *

What campus organizations, sports or activities are you involved in? *

Please respond in complete sentences.

Who is your faculty advisor? *

What is the title of your research? *

Please explain your research: *

Please respond in complete sentences

Will you continue with your research beyond this summer? If so, please explain next steps and your vision for the final paper. *

What are your aspirations after Goucher? How will this research help you achieve your career goals? *